Provider Demographics
NPI:1124046453
Name:MARTIN, TIFFANY G (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:G
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 WEDGEWOOD DR.
Mailing Address - Street 2:CAROLINA PARENTING SOLUTIONS
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-9253
Mailing Address - Country:US
Mailing Address - Phone:704-718-8657
Mailing Address - Fax:704-821-4831
Practice Address - Street 1:2329 WEDGEWOOD DR.
Practice Address - Street 2:CAROLINA PARENTING SOLUTIONS
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28104-9253
Practice Address - Country:US
Practice Address - Phone:704-718-8657
Practice Address - Fax:704-821-4831
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003618Medicaid